Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal–Fetal Mortality

Abstract

Background Appendicitis is the most common extra-uterine surgical emergency requiring immediate intervention during pregnancy. However, risks for mortality and morbidity among pregnant women with appendicitis remain poorly understood. This study was conducted to determine the temporal trends of appendicitis in pregnant women, and to calculate the risk of maternal–fetal mortality and near-miss marker (i.e., cardiac arrest) among pregnant women in general, and by race/ethnicity. Methods We conducted this retrospective study using data from the Nationwide Inpatient Sample (NIS) from January 1, 2002, through December 31, 2015. Joinpoint regression was used to estimate and describe temporal changes in the rates of all and acute appendicitis during the 14-year study period. We also estimated the risk of cardiac arrest, maternal, and fetal mortality among mothers of various racial/ethnic groups with a diagnosis of acute appendicitis. Within each group, patients without acute appendicitis were the referent category. Results and conclusions Out of the 58 million pregnancy hospitalizations during the study period, 63,145 cases (10.74 per 10,000 hospitalizations) were for acute appendicitis. There was a 5% decline (95% CI: − 5.1, − 5.0) in the rate of appendicitis hospitalizations over the period of the study. After adjusting for covariates, pregnant mothers with acute appendicitis had increased likelihood when compared to those without acute appendicitis to suffer fetal loss (OR: 2.05, 95% CI: 1.85–2.28) and nearly fivefold increase for inpatient maternal death. In conclusion, appendicitis during pregnancy remains an important cause of in-hospital maternal–fetal mortality overall and regardless of race/ethnicity.

Obstetric cardiopulmonary arrest: construction and validation of an instrument to assess nursing knowledge

“…A study conducted in the United States highlighted the low level of knowledge associated with low quality in practical skills as obstacles in performing maternal CPR. This situation is worsened when considering that many professionals, even those trained to work in obstetric emergencies, tend to show a loss in knowledge over time (22,23) .…”

Parada cardiorrespiratória obstétrica: construção e validação de instrumento para avaliar o conhecimento da enfermagem

“…Estudo realizado nos Estados Unidos destacou o baixo nível de conhecimento associado à baixa qualidade nas habilidades práticas, como obstáculos na realização da RCP materna. Essa situação é agravada ao considerar que muitos profissionais, mesmo os treinados para atuar em emergências obstétricas, tendem a apresentar declínio no conhecimento com o passar do tempo (22,23) .…”

Management for Acute Uncomplicated Appendicitis During Pregnancy

“…3,4 Appendectomy constitutes nearly 25% of all nonobstetric surgical procedures in pregnant women, 4 and has a prevalence of about 1 in every 1400 to 1500 births. 5 Since the early 1900s, appendectomy has been considered the standard of care for pregnant women with acute uncomplicated appendicitis. 4,6 Although both open appendectomy (OA) and laparoscopic appendectomy (LA) are acceptable, 4 current national societal guidelines recommend LA, even during pregnancy.…”

“…Acute appendicitis is one of the most common causes of abdominal pain in pregnant women 1,2 and the most common nonobstetric surgical emergency 3,4 . Appendectomy constitutes nearly 25% of all nonobstetric surgical procedures in pregnant women, 4 and has a prevalence of about 1 in every 1400 to 1500 births 5 . Since the early 1900s, appendectomy has been considered the standard of care for pregnant women with acute uncomplicated appendicitis 4,6 .…”